AAO-HNSF Primary Care Otolaryngology Handbook

RHINOLOGY, NASAL OBSTRUCTION, AND SINUSITIS

a submucosal inferior turbinate reduction, is reserved for cases refractory to medical treatment. Nasal Polyps Nasal polyps are localized growths of extremely edematous nasal or sinus mucosa (Figure 8.6). They can enlarge in response to allergies or infec- tion and obstruct either the nose or the ostia through which the sinuses drain, leading to chronic sinusitis and anosmia. The exact cause of polyps

is not known, but 50 percent of patients who have polyps also have allergies, so patients with polyps should be evaluated for allergies. Polyps usually respond very well to a course of systemic steroids followed by continuous intranasal steroid sprays. Surgery may be indicated if the polyps recur frequently or do not respond to treatment. However, recurrence is common. Samter’s triad—consisting of asthma, an allergy to aspirin, and nasal polyposis—is a particularly difficult-to-treat form of this disease. Inflammatory polyps are bilat- eral. Unilateral nasal polyps may be a manifestation of a neoplasm and must be referred to an otolaryngologist for evalua- tion. Polyps in children are uncommon and should prompt a workup for cystic fibrosis.

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Figure 8.6. Photograph of a nasal polyp. Nasal polyposis is a common ailment that results in nasal obstruction and drainage. Most patients require medical treatment with topical steroids and antibiotics, as well as surgical removal of polyps and diseased tissue.

Another relatively frequent cause of nasal blockage is rhinitis medica- mentosa . This syndrome develops when people repeatedly use decon- gestant nasal sprays (oxymetazoline, neosynephrine) over a long period. The rebound effect causes patients to use topical decongestant even more frequently to breathe. After prolonged use, the mucosa becomes quite inflamed. The treatment is discontinuation of the decongestant sprays. Symptoms can be reduced by intranasal steroid spray, occasion- ally accompanied by short bursts of systemic steroids. Cocaine abuse can also cause this problem. Cocaine may also induce ischemic necrosis in the nasal septum because of the amount of vasoconstriction. The isch- emia then may result in a nasal septal perforation , which interferes with nasal airflow and is very difficult to repair surgically.

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